ribavarin dose with Teleprevir

[pcds]

I just received my med and saw the doc orders 600mg of rbavarin.  When I treated last time I used 1000.  I called the office he's out of town.  Did he make a mistake?  If so now I worry about his being sloppy .  If I hadn't treated before I would be in trouble.  Not a great way to start off with a new doc.

[elpasolady]

WOW.....this has become a great, important, discussion, for sure. Thanks for all the inputs!
After more research, and reading comments from this forum, below is what I decided all the confusion may be about, for me at least, and possibly my Dr.
  
My Dr. told me that she did not have anyone on the Pegasys, only the Peg-intron. If you read below, even though the last sentence confers with what everyone has been saying about 1000 mg, , it's possible that she is used to dosing based on the Peg-Intron approved dose, which you will read, is 800 mg.
  I will find out more when I talk to her later today. I will tell her that I WANT the 1000 mg of Riba which is the approved dose for Pegasys, which is what I will be taking.  
I hope this clears things up a bit. If it weren't for you all, it is possible I would have jeopordized my chance of UND at 4 weeks due to not enough Riba.  Of course we will never know, but like you say, better safe than sorry!!!  

My heartfelt thanks for this entire conversation!


~~~Ribavirin comes in 200 mg tablets or capsules. The approved dose of ribavirin when used with Pegasys is 1,000-1,200 mg (5-6 tablets) daily, split into a morning dose (2-3 tablets) and an evening dose (3 tablets). The actual dose is based on body weight: people who weigh less than 165 lbs. take 1,000 mg daily, and people who weigh 165 lbs. or more take 1,200 mg daily. People with genotype 2 or 3 only need 800 mg daily, split into a morning dose (2 tablets) and an evening dose (2 tablets), regardless of weight.

The approved dose of ribavirin when used with Peg-Intron is 800 mg (4 tablets) daily, split into a morning and an evening dose. However most doctors would prescribe 1,000-1,200 mg, based on body weight, and expect the approved dose to change when more data is available. ~~~

[Proactive]

I don't know as the high doses in the Lindahl study are being suggested here.(not by me anyway)
Here is the full study I believe you are referencing.
http://diss.kib.ki.se/2005/91-7140-348-5/thesis.pdf

[desrt]

"Fatigue 10 Moderate to severe
Pruritus or dermatitis 9 Moderate to severe
Nausea 7 All patients were treated with ondansetron
Aphthous ulcers 3  
Oral candida 2 Responded well to fluconazole
Blurred vision 2  
Diabetes mellitus 1 Started at treatment week 10, insulin dependent
Brown spots 1 Oral cavity
Migraine 1 Severe attack in association with a rapid hemoglobin drop "

[desrt]

From the link posted by flcyclist:

"The side effects were more frequent and serious, in particular potentially life-threatening anemia, than those observed with standard combination treatment."

IFN/riba have never been Rx'd by what *works* but by how much the average patient can *tolerate* without sustaining an unacceptable amount of damage.

[Proactive]

Pre PI data

"A positive linear relationship exists between ribavirin dose and SVR; ribavirin doses greater than 10.6 mg/kg/d have higher SVR rates"
http://depts.washington.edu/hepstudy/hepC/mgmt/anemia/discussion.html

[Proactive]

actually, someone posted "the higher the dose you can tolerate, the better--guided by hgb levels" to be precise.

"overdose of ribavirin although rare can be fatal esp if other conditions are present -

I've never heard of a ribavirin overdose. If memory serves,I did read in the ribavirin fda approval notes where one patient took 50 pills..no overdose.
Interested in your source, a link would be great TIA